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Impact of Atrioventricular Compliance on Clinical Outcome of Patients Undergoing Successful Percutaneous Balloon Mitral Valvuloplasty
Author(s) -
Mahfouz Ragab A,
Elawady Waled,
Hossein Ekhlas,
Yosri Ahmad
Publication year - 2013
Publication title -
echocardiography
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.404
H-Index - 62
eISSN - 1540-8175
pISSN - 0742-2822
DOI - 10.1111/echo.12256
Subject(s) - medicine , cardiology , atrial fibrillation , ventricle , pulmonary artery , mitral regurgitation , balloon , percutaneous , atrioventricular valve , central venous pressure , blood pressure , heart rate
Objective We aimed to assess the impact of atrioventricular compliance ( Cn ) on the clinical outcome, after successful percutaneous balloon mitral valvuloplasty ( PBMV ). Methods and Results Using Doppler echocardiography Cn was estimated from the equation that has been previously validated. Mitral valve area ( MVA ), tricuspid annular plane systolic excursion ( TAPSE ), pulmonary artery pressure ( PAP ), and degree of tricuspid regurgitation ( TR ) severity were evaluated before, immediately, and every 6 months with a median duration of 32 months after successful PBMV in 150 consecutive patients. An immediate drop in PAP and significant improvement of right ventricle ( RV ) function was observed after PBMV . Cn was negatively correlated pre and post‐ PBMV , with the degree of pulmonary artery systolic pressure (PAPs), TAPSE (P < 0.0001). Patients with Cn ≤ 3.75 mL/mmHg had higher incidence of adverse outcome (developing atrial fibrillation [AF], worsening RV function, progressive left atrial dilation, and redo intervention). Multivariate regression analysis showed that the Cn was the strongest independent predictor of PAP s and RV function before and after successful PBMV (P < 0.0001). Cn ≤ 3.75 mL/mmHg was the cutoff value for prediction of clinical events at follow‐up. Conclusions Atrioventricular compliance was significantly lower in patients with mitral stenosis (MS) with unfavorable outcome after successful PBMV . The RV function and pulmonary hypertension were significantly correlated with the degree of Cn. This suggests a significant role of Cn in patients with MS, providing a good insight for intervention and utilizing Cn as a noninvasive hemodynamic index for risk stratification and proper timing for intervention in patients with MS .